抗菌光动力疗法与全身抗菌药物辅助治疗牙周炎疗效比较的Meta分析

doi:10.7518/gjkq.2024074

摘要/Abstract

摘要：

目的比较抗菌光动力疗法（aPDT）与全身抗菌药物辅助治疗牙周炎的疗效。方法搜索Embase、PubMed、Web of Science、Cochrane Library、中国知网、万方数据库、维普数据库共7个数据库，搜索时间从建库至2023年11月止，被搜索文献的语言类型为中文或英文。根据纳入排除标准筛选文献。用Cochrane工具进行文献质量评价。用 RevMan 5.4软件和Stata 14.0软件对被纳入的文献进行Meta分析和发表偏倚检测。结果共有8篇文献被纳入。Meta分析结果表明，治疗后3个月时，当光敏剂（PS）为亚甲基蓝（MB）时，龈下刮治和根面平整术（SRP）+aPDT对探诊深度（PD）的改善效果优于SRP+全身抗菌药物；治疗后3个月时，当PS为吩噻嗪氯时，SRP+全身抗菌药物对PD的改善效果优于SRP+aPDT（P<0.05）。治疗后3个月，SRP+aPDT/SRP+全身抗菌药物对临床附着水平（CAL）、探诊出血（BOP）的改善效果均无明显区别（P>0.05）；治疗后6个月，SRP+aPDT/SRP+全身抗菌药物对PD、CAL、BOP的改善效果均无明显区别（P>0.05）。与基线期相比，治疗后3个月时，SRP+aPDT使PD、CAL、BOP分别改善了（0.80±0.19） mm、（0.94±0.29）mm、19.74%±1.91%（P<0.05）；而SRP+全身抗菌药物使PD、CAL、BOP分别改善了（1.02±0.27）mm、（0.95±0.25） mm、19.39%±11.83%（P<0.05）。治疗后6个月，SRP+aPDT使PD、CAL、BOP分别改善了（1.37±0.47） mm、（1.29±0.52） mm、28.97%± 2.43%（P<0.05）；而SRP+全身抗菌药物使PD、CAL、BOP分别改善了（1.55±0.53） mm、（1.34±0.49） mm、29.34%± 10.47%（P<0.05）。结论 SRP+MB-aPDT对PD的改善效果优于SRP+全身抗菌药物；SRP+全身抗菌药物对PD的改善效果优于SRP+吩噻嗪氯-aPDT，MB-aPDT或许能成为全身抗菌药物辅助治疗牙周炎的替代方法。牙周炎类型、2型糖尿病、吸烟、aPDT次数、全身抗菌药物的种类及其治疗时间等因素对于SRP+aPDT/SRP+全身抗菌药物的治疗效果影响相当。

关键词: 抗菌光动力疗法, 抗菌药物, 龈下刮治和根面平整术, 牙周炎, Meta分析

Abstract:

Objective This study aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) and systemic antimicrobial drug as an adjunct treatment for periodontitis. Methods 　Seven databases, namely, Embase, PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP, were searched from inception until November 2023. The language of the searched literature is Chinese or English. Studies were screened out according to inclusion and exclusion criteria, and their quality was evaluated using the Cochrane tool. Meta-analysis and publication bias detection of the included studies were performed using RevMan 5.4 and Stata 14.0 software. Results Eight studies were included. Meta-analysis showed that 3 months after treatment using methylene blue (MB) as the photosensitizer (PS), the improvement effect of scaling and root planning (SRP)+aPDT on probing depth (PD) was better than that of SRP+systemic antimicrobial drug. When phenothiazine chloride was the PS, the improvement effect of SRP+systemic antimicrobial drug on PD was better than that of SRP+aPDT (P<0.05). No significant difference was observed in the improvement effect of SRP+aPDT/SRP+systemic antimicrobial drug on clinical attachment level (CAL) and probing bleeding (BOP) at 3 months after treatment (P>0.05) and the improvement effect of SRP+aPDT/SRP+systemic antimicrobial drug on PD, CAL, and BOP at 6 months after treatment (P>0.05). Compared with those at baseline, SRP+aPDT improved PD, CAL, and BOP by (0.80±0.19) mm, (0.94±0.29) mm, and 19.74%±1.91%, respectively, at 3 months after treatment (P<0.05). In addition, SRP+systemic antimicrobial drug improved PD, CAL, and BOP by (1.02±0.27) mm, (0.95±0.25) mm, and 19.39%±11.83%, respectively (P<0.05). At 6 months after treatment, SRP+aPDT improved PD, CAL, and BOP by (1.37±0.47) mm, (1.29±0.52) mm, and 28.97%±2.43%, respectively (P<0.05). In addition, SRP+systemic antimicrobial drug improved PD, CAL, and BOP by (1.55±0.53) mm, (1.34±0.49) mm, and 29.34%±10.47%, respectively (P<0.05). Conclusion For PD, the improvement effect is in the order of SRP+MB-aPDT>SRP+systemic antimicrobial drug> SRP+phenothiazine chloride-aPDT. MB-aPDT may be an alternative to systemic antimicrobial drug as an adjunct treatment for periodontitis. The type of periodontitis, type 2 diabetes mellitus, smoking, number of aPDT, type of systemic antimicrobial drug, and treatment time of systemic antimicrobial drug have a similar influence on the treatment effect of SRP+aPDT/SRP+systemic antimicrobial drug.

Key words: antimicrobial photodynamic therapy, antimicrobial drug, scaling and root planning, periodontitis, Meta analysis

中图分类号:

R781.4

马玉, 左玉, 刘建华. 抗菌光动力疗法与全身抗菌药物辅助治疗牙周炎疗效比较的Meta分析[J]. 国际口腔医学杂志, 2024, 51(4): 406-415.

Yu Ma, Yu Zuo, Jianhua Liu. Meta-analysis of the efficacy of antimicrobial photodynamic therapy and systemic antimicrobial drug as an adjunct treatment for periodontitis[J]. Int J Stomatol, 2024, 51(4): 406-415.

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研究	发表年份	纳入人数	SRP+aPDT组（年龄/岁）	SRP+全身抗菌药物组（年龄/岁）	牙周炎类型	有/无 T2DM	是否吸烟	PS种类	aPDT次数	全身抗菌药物治疗时间/d	全身抗菌药物的种类
Al-Khureif等^[13]	2020	17	29.61±3.2	31.44±2.4	AP	无	否	吩噻嗪氯	4	7	AMX+MTZ
Al-Zahrani等^[14]	2009	30	51.92±7.28	51.42±6.24	CP	有	是	MB	1	14	Dox
Arweiler等^[15]	2013	35	37.4±8.0	34.7±9.1	AP	无	否	吩噻嗪氯	2	7	AMX+MTZ
Arweiler等^[16]	2014	35	37.3±8.0	34.7±9.0	AP	无	否	吩噻嗪氯	1	7	AMX+MTZ
Ramos等^[17]	2016	30	48.9±9.5	49.3±7.4	CP	有	否	吩噻嗪氯	4	14	Dox
Skaleri?等^[10]	2023	20	未描述	未描述	AP	无	否	吩噻嗪氯	2	7	AMX+MTZ
Theodoro等^[18]	2017	27	48.8±8.3	46.3±6.8	CP	无	否	MB	3	7	AMX+MTZ
Theodoro等^[19]	2018	29	48.8±3.9	48.9±5.1	CP	无	是	MB	3	7	AMX+MTZ

研究	随机分配方法	分配方案隐藏	研究者或患者的盲法	检查者盲法	文献数据完整性	选择性报告研究结果	其他偏倚来源
Al-Khureif等^[13]	随机比例块	按顺序编号的密封不透明信封来确保对随机化的盲法	研究者和患者盲法	盲法	完整	无选择性报告	未描述
Al-Zahrani等^[14]	计算机生成的随机数字表	未描述	患者盲法	盲法	完整	无选择性报告	未描述
Arweiler等^[15]	未描述	未描述	未描述	盲法	完整	无选择性报告	未描述
Arweiler等^[16]	未描述	未描述	未描述	盲法	完整	无选择性报告	未描述
Ramos等^[17]	计算机生成的随机数字表	按顺序编号的密封不透明信封来确保对随机化的盲法	未描述	未描述	完整	无选择性报告	未描述
Skaleri?等^[10]	计算机生成的随机数字表	按顺序编号的密封不透明信封来确保对随机化的盲法	未描述	未描述	完整	无选择性报告	未描述
Theodoro等^[18]	计算机生成的随机数字表	按顺序编号的密封不透明信封来确保对随机化的盲法	研究者盲法	盲法	完整	无选择性报告	未描述
Theodoro等^[19]	未描述	未描述	未描述	未描述	完整	无选择性报告	未描述

结局指标	随访时间/月	纳入人数	SMD	95% CI	P值
PD/mm	3	188	0.14	-0.21~0.49	0.43
	6	106	0.25	-0.31~0.82	0.38
CAL/mm	3	188	0.05	-0.15~0.26	0.61
	6	106	0.21	-0.52~0.95	0.57
BOP/%	3	138	-1.20	-3.98~1.59	0.40
	6	81	0.07	-12.07~12.21	0.99

结局指标	随访时间/月	试验组（SRP+aPDT）			对照组（SRP+全身抗菌药物）
结局指标	随访时间/月	纳入人数	Mean±SD	P值	纳入人数	Mean±SD	P值
PD/mm	3	93	-（0.80±0.19）	<0.01	95	-（1.02±0.27）	<0.01
	6	53	-（1.37±0.47）	<0.01	53	-（1.55±0.53）	<0.01
CAL/mm	3	93	-（0.94±0.29）	<0.01	95	-（0.95±0.25）	<0.01
	6	53	-（1.29±0.52）	0.01	53	-（1.34±0.49）	<0.01
BOP/%	3	68	-（19.74±1.91）	<0.01	70	-（19.39±11.83）	<0.01
	6	40	-（28.97±2.43）	<0.01	41	-（29.34±10.47）	<0.01

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